MEDICARE: MR. JEAN MATUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	NURRNLIC102657	MT

General Provider Information

NPI Number	:	1962298869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN MATUS

Provider Business Mailing Address
First Line	:	1208 PARK GARDEN RD
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3628
Country	:	US
Telephone Number	:	406-403-9728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 PARK GARDEN RD
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3628
Country	:	US
Telephone Number	:	406-403-9728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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